A review of the effects of thickened feeds on gastroesophageal reflux in infants

Thickened infant formulas containing either rice cereal, carob bean gum, carob seed flour and/or carboxy methylcellulose are increasingly being used in the treatment of gastroesphageal reflux (GER) in infants. GER occurs when the infant's stomach contents pass back into the oeosphagus resulting in vomitng, poor weight gain, pain, dysphagia and respiratory disorders.   A systematic review and meta analysis of the data from randomized controlled trials was undertaken to evaluate the efficacy and safety of using thickened formulas for GER.

Guidelines from the Cochrane Collaboration were followed to conduct the systematic review and meta-analysis.  Only randomized controlled trials evaluating the use thickened feeds to treat GER in infants for more than a few days were included. Fourteen trials with a parallel or cross over design ended up being included.

Compared to standard feeds the thickened feeds resulted in more infants having no regurgitation and slightly reduced the number of  daily episodes of regurgitation and vomiting resulting in daily weight gain. Thickened feeds had no effect on reflux index ( the percentage of time when pH was <4), number of GER episodes per hour or number of reflux episodes lasting more than 5 minutes. They did reduce the duration of the longest reflux episode (pH<4). There were no adverse effects and no one particular thickening agent was best.

The study concluded that thickened feeds are moderately effective in treating reflux in infants.

Reference

Horvath A, Dziechciarc P, Szajewska H. The effect of thickened-feed interventions on gastroesophageal reflux in infants:systematic and meta-analysis of randomized, controlled trials. Pediatrics 2008. Online article DOI:10.1542/peds.2008-1900  www.pediatrics.org